Ask the Experts, News, Skilled Nursing Facility

Ask the expert: Ambulance billing

Q: I work in ambulance billing.  I know that under Original Medicare, many non-emergent transports of bed confined and non-wheelchair patients is billable to the SNF.  Is the same true for Medicare Advantage plans? Also, is there some way to tell when to bill the SNF?


A:  Medicare Advantage plans are not subject to consolidated billing rules, but are subject to Medicare coverage guidelines. If the transport does not meet the Medicare coverage guidelines, then Medicare cannot be billed.  Depending on the facility contract with the MAO, they may have addressed this issue in the contract or they may be passing the bill onto the patient.